New NIH research shows quitting smoking boosts recovery odds by 42%—yet most treatment centers still allow it

For decades, cigarette smoking has been treated as a tolerated side habit in addiction treatment—something to address “later,” if at all. Many residential and outpatient programs still allow it, citing fears that quitting will be too overwhelming in early recovery.

But the research is clear: smoking isn’t just a separate health risk—it’s a relapse risk factor that can undermine recovery from other addictions. Continuing to ignore tobacco use in treatment settings isn’t compassionate; it’s counterproductive. And in today’s strained healthcare climate, it’s negligent.

The 2024 NIH PATH Study: A Game-Changer

A 2024 NIH-funded analysis from the Population Assessment of Tobacco and Health (PATH) Study followed 2,652 adults with a history of substance use disorder for four years. The findings were striking:

• People who quit smoking during the study had 42% greater odds of being in recovery from their non-tobacco substance use disorder compared to those who kept smoking.

• The association held true even after accounting for confounding factors—meaning the results are generalizable to millions of adults with SUD.

Dr. Nora Volkow, Director of NIDA, stated:

“It underscores the importance of addressing different addictions together, rather than in isolation.”

Not an Outlier: Other Studies Show the Same Pattern

The PATH findings are powerful, but they’re not the only evidence we have.

• Lien, Bolstad, & Bramness (2021) – In BMC Psychiatry, researchers found that smokers in inpatient SUD treatment had poorer mental health and lower quality of life compared to nonsmokers, suggesting tobacco use can hinder emotional recovery.

• Weinberger et al. (JCP) – A study of over 30,000 participants found that smoking was significantly associated with higher relapse risk to alcohol and other drug use.

The Cost Crisis: We Can’t Afford “Same Old, Same Old”

Treatment and behavioral health service costs are climbing. Meanwhile, recent federal and state budget cuts are shrinking the funding streams programs rely on. We cannot afford to keep pouring resources into outdated approaches when lives are at stake and the data points us toward better outcomes.

Clients and their families deserve to know about cutting-edge strategies that give them the best possible shot at long-term recovery. Imagine if your oncologist failed to tell you about a lifestyle change that could reduce your cancer recurrence risk by 42%—we would all call that malpractice.

That’s the kind of negligence our field risks if we don’t inform clients about the proven recovery benefits of quitting smoking. People have a right to make informed decisions about their treatment episodes and set goals that include the full range of evidence-based interventions.

The Industry’s Blind Spot: Staff Smoking and Client Services

So, if we’ve had research before this 2024 study, why hasn’t the addiction industry moved on this at all? One reason may be uncomfortable but undeniable: it’s no secret that many people who work in addiction treatment are in recovery themselves, and that individuals with mental health or substance use disorders have higher smoking rates than the general public.

This means many staff in treatment settings are still dependent on nicotine—and that dependency can shape treatment culture. A 2022 study by Joseph Guydish, Thao Le, Sindhushree Hosakote, Elana Straus, Jessie Wong, Cristina Martínez, and Kevin Delucchi (Journal of Substance Abuse Treatment, 132, 108496) found that the more staff who smoked, the fewer smoking cessation services were offered to clients.

It’s clear we also need to:

• Provide cessation services and education for staff so they can understand—and model—the importance of quitting.

• Hold staff accountable for addressing their own bias around smoking, and help them work through any internal shame that keeps them from discussing it openly with clients.

Until treatment staff are both empowered and expected to address nicotine dependence, many clients will never hear about the role smoking plays in recovery success.

The Policy Problem: Tobacco as a Treatment Center Draw

Even when the evidence is clear, the market reality of addiction treatment can keep programs from acting. If one facility bans smoking but others don’t, clients may “program shop” for the places that allow tobacco. This isn’t speculation—it’s how the disease of addiction works. People naturally gravitate toward the path of least resistance.

That’s why piecemeal change won’t work. Just as smoking is banned in and around hospitals and schools, it should be banned in all licensed addiction treatment centers—statewide, all at once—to prevent treatment-hopping and ensure consistent standards of care.

What Treatment Leaders Can Do Now

1. Integrate Smoking Cessation into Psychoeducation
   Make tobacco education and cessation planning a required part of the curriculum—not an optional side note.

2. Assess Nicotine Dependence at Intake
   Counselors should use validated tools to assess nicotine use and incorporate it into individualized treatment plans.

3. Use Motivational Interviewing
   Treat tobacco use the same way you would any other addiction—by exploring ambivalence, building commitment, and developing a realistic quit plan.

4. Support Staff, Not Just Clients
   Create staff-focused cessation programs and professional expectations around addressing nicotine use with clients.

A Call to States: Set the Standard

State licensing authorities and health departments have the power to make this change. Mandating tobacco-free treatment environments across the board would:

• Eliminate treatment-shopping based on tobacco use.

• Align addiction treatment policy with hospital and school tobacco restrictions.

• Improve long-term recovery rates and reduce relapse risk.

The 2024 NIH PATH study isn’t an isolated finding—it’s the latest in a long chain of evidence showing that smoking cessation is not just a health benefit, but a recovery multiplier.

If we truly believe in evidence-based treatment, the era of the smoking lounge in rehab must end—for the health, dignity, and future of every person seeking recovery, and for the integrity of the field itself.

Tobacco-Free Treatment Centers: “What the Opponents Say” FAQ And How You Can Respond:

1. “Clients already have enough barriers to getting into treatment. We don’t need to force them to quit smoking as an added deterrent.”

Response:
This isn’t about turning people away—it’s about removing a barrier to long-term recovery. Smoking isn’t harmless; it increases relapse risk, worsens mental health, and lowers quality of life. A tobacco-free policy means clients get support—nicotine replacement, counseling, and peer guidance—starting on day one. We don’t ban them for smoking; we help them quit while they’re here, giving them a better chance to succeed.

2. “It’s unrealistic to expect someone to quit everything at once.”

Response:
Research proves it’s not only realistic—it’s more effective. The 2024 NIH PATH Study found that people who quit smoking during treatment had 42% greater odds of maintaining recovery from alcohol or other drugs. Tackling nicotine dependence alongside other addictions uses the same clinical tools—motivational interviewing, relapse prevention, and behavioral supports—and strengthens, not weakens, recovery outcomes.

3. “Smoking is one of the only coping tools clients have in early recovery.”

Response:
Nicotine dependence isn’t a coping skill—it’s another addiction with its own withdrawal cycle, anxiety spikes, and health risks. Allowing smoking reinforces the idea that harmful substances are an acceptable stress reliever. Teaching clients healthier coping strategies from the start replaces nicotine with tools that don’t jeopardize recovery.

4. “If we ban smoking, clients will just go to another program that allows it.”

Response:
That’s why this policy needs to be statewide and implemented at the same time across all licensed programs. This removes the “treatment shopping” problem and ensures equitable, evidence-based care. We don’t let programs keep alcohol or illicit substances on-site to attract clients—tobacco should be no different.

5. “Staff smoke too. This will be impossible to enforce.”

Response:
A 2022 study in the Journal of Substance Abuse Treatment found that the more staff who smoke, the fewer cessation services are offered to clients. This is a culture issue as much as a clinical one. The solution is twofold: provide robust cessation programs for staff and set clear professional expectations. Directors can model best practices by making tobacco-free care the standard for everyone in the treatment environment.

6. “We’ll lose staff if we require a tobacco-free workplace.”

Response:
When hospitals, schools, and government agencies went tobacco-free, there were initial concerns—but with clear timelines, supportive resources, and strong leadership, compliance became the norm. The mission of addiction treatment is to save lives and support recovery; aligning staff behavior with that mission strengthens our credibility and outcomes.

7. “Our clients aren’t asking for this.”

Response:
Clients don’t always know the full scope of evidence-based practices—that’s our job. Imagine if an oncologist didn’t tell a patient about a change that could cut cancer recurrence risk by 42%. Withholding proven strategies for recovery is a disservice. Clients deserve to know this information so they can make informed treatment decisions.

About the Author

Carmichael Finn, MA, LMFT, LADC, ADCR-MN, is the Executive Director of Recovering Hope Treatment Center in Mora, Minnesota, a family-centered substance use disorder program serving individuals and families. With over two decades of experience in behavioral health leadership, clinical supervision, and policy advocacy, Carmichael is committed to advancing evidence-based practices that improve recovery outcomes. He is a licensed marriage and family therapist and alcohol and drug counselor, an adjunct faculty member teaching future addiction professionals, and an active voice in state and national conversations on treatment innovation and ethics. Carmichael writes regularly on workforce sustainability, moral injury in healthcare, and strategies that give clients the best possible chance at long-term recovery.